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At age 20, David did not want to deal with the fact that he might have a problem. Although he was getting married in a few hours, he had spent the previous night having sex with his best man.
David pulled himself together and went through with the marriage ceremony. For 25 years he slept only with women. He fathered two sons and eventually left his wife for another woman. When that affair ended David, now 48, finally told his family and friends that he was gay.
"I desperately wanted not to be gay," David now freely admits, "so I had convinced myself that I wasn't." However, when his last relationship with a woman broke up, David realized that he had no desire to date other women. He also realized that he did not want to be alone for the rest of his life. "I realized," he says, "that I had to sit myself down and deal with my sexuality."
At the time, David felt he had only two choices: he could admit that he was gay and live the rest of his life as a homosexual or he could kill himself. "I wanted to live, not die," he said. "Given that choice, I had nothing to lose."
The transformation in David's life underscores the issue of whether sexual orientation is a choice or a predisposition—a topic that invokes passionate debate among healthcare professionals. politicians, and religious adherents.
The American Psychological Association defines sexual orientation as an emotional, romantic, sexual, or attraction to men, women, or both. However, sexual orientation is different from sexual behavior. Sexual orientation is merely an innate attraction. Sexuality is a range of attractions and behaviors. Some may label themselves, while others may not.
Although it is unclear how orientation comes about, evidence shows that it starts to appear between middle childhood and early adolescence. The orientation will dictate attraction, but this does not mean that people will express their sexual orientation in their behaviors. Behaviors may be heavily influenced by pressure from families, relationships, or general society. In other words, it is possible to be attracted to the same sex without acting on it. This is how some people live a fully heterosexual life for years before embracing a homosexual relationship.
In 1973, The Board of Trustees for the American Psychiatric Association voted to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders and thus formally declassified it as a mental illness.
If it is not a mental illness, then can it be changed? That is the crux of the debate. A sizable group of religious leaders, as well as a number of mental health professionals, advocate that reparative therapy, also known as conversion therapy, can change a person's sexual orientation from homosexual to heterosexual. Another group of mental health professionals, educators, and public officials—the National Association for Research and Therapy of Homosexuality (NARTH)—also assert that homosexuality can be treated by addressing unwanted homosexual feelings.
The American Psychiatric Association (APA), on the other hand, expresses concern that these therapies do not work. APA points to the lack of evidence, and further points out that these therapies can be harmful by reinforcing stereotypes. Negative attitudes about homosexuality contribute to discrimination and family rejection, which put people at risk for suicide or depression.
The concerns over conversion (or reparative) therapy were so strong that some states have or are considering banning the practice. California became the first state to ban conversion therapy practices on minors. As of 2013, no mental health provider was able to provide services to change behavior in people with romantic attractions or feelings to others of the same sex. However, conversion therapy bans continuously undergo legal changes. Many decisions go through appeal processes, which may result in a reversed decisions.
No matter what side you take, there are ways to help you or a family member to cope with the challenges ahead.
For some people, accepting homosexuality is easier than for others. There are several factors that affect whether someone has a positive or negative experience. Fear of family rejection, discrimination, or being exposed can add stress to an already difficult situation. Acceptance is an important psychological step, and is an on-going process.
Judith is a case in point. She had been raised in a "fairly religious, conservative" family in the Midwest. A virgin when she married, Judith had never been excited about dating men. Although she was married for 14 years and had a child, she says she did not feel particularly close to her husband.
For Judith, coming out was a seven-year process that began after she attended a lecture given by a gay woman. "Something just clicked," Judith now says, but not at first. She was initially reluctant to admit, even to herself, that she might be gay. She was raised believing that being homosexual meant you were mentally ill, "and I knew I wasn't crazy," she now says.
Unlike David who knew, but tried to repress the fact that he was attracted to men, Judith says that she was unaware of her homosexual orientation. She just knew something was not right.
What finally made Judith recognize her sexual orientation? "I realized that I needed to acknowledge who I am," she says, "I wasn't comfortable with living that other life."
Today Judith says that she is at ease with herself, having found joy and normalcy in her life.
David and Judith are both finally comfortable with their homosexuality, and both believe that sexual orientation is not something that can be changed. They both insist that the lives they lead are perfectly normal.
"I go to the movies, pay rent, and love my partner, just like heterosexual people do," David insists.
For Judith, it is all summed up in one sentence: "I don't have a lifestyle," she says. "I have a life."
Remember you are not alone and there are places to turn for help. Talk to your doctor or a support group, and see what resources are in your area.
American Sexual Health Association
PFLAG Canada—Parents, Families, and Friends of Lesbians and Gays
Sexual orientation and gender identity. American Psychological Association website. Available at: http://www.apa.org/helpcenter/sexual-orientation.aspx. Accessed August 3, 2016.
Stigma and discrimination. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/msmhealth/stigma-and-discrimination.htm. Updated February 29, 2016. Accessed August 3, 2016.
Last reviewed August 2016 by Michael Woods, MD Last Updated: 8/3/2016